DCD/DYSPRAXIA

TDC/DYSPRAXIE

Dyspraxia and Developmental Coordination Disorder (DCD) are often used synonymously. The term dyspraxia is still widely used in Europe, whereas in North America, the acronym DCD is more common. For our purposes, both names are treated as synonyms. However, for the exact definitions: dyspraxia refers more to gesture, whereas DCD refers to movement. The difference between gesture and movement are described in detail in the following link (in French):   https://ergomotricite.eu/gestes-versus-mouvements.html

DCD/dyspraxia is defined as a disorder in the development and automation of motor gestures to perform an action or activity. These people thus have a neurological disorder that limits their ability to develop adequate control of motor gestures despite their best efforts, what they are experiencing, or any stimulation.

Dyspraxia and DCD are medical diagnoses that are part of neurodevelopmental disorders.

Causes:

Although no specific link to its cause or causes has been determined yet, the disorder appears to have several potential causes, based on some evidence that has been observed. A lack of “in utero” brain maturation (prematurity) or a neurological/metabolic disorder (neonatal epilepsy, a glucose transporter 2 [GLUT2] deficiency) could be involved. Genetic/family factors are also being examined and identified. It is not uncommon for more than one child among siblings to be affected or to have a parent who is affected.

In summary, DCD/dyspraxia is manifested as follows:

Physically, dyspraxia or DCD is manifested through clumsiness in motor and sports activities, a lack of coordination, and a lack of fine motor skills.

Socio-emotionally, dyspraxia leads to a certain fear of novelty and a low tolerance to frustration.

There is also awkwardness in social relationships that can compromise integration in various settings.

Diagnosis

In Quebec, only physicians have the ability and authorization to diagnose this disorder. The physician will first ensure that the child does not suffer from a pathology (illness). Based on observations by parents and sometimes preschool or school educators and practitioners, the physician will consult other specialists to draw up a multidisciplinary profile. Occupational therapists are the primary specialists, followed by speech-language pathologists, psychologists and/or neuropsychologists, and optometrists.

Management

In Quebec, the occupational therapist is the specialist who provides the most comprehensive diagnostic assessment and manages the rehabilitation of the child with dyspraxia.

The occupational therapist will assess the child’s skills, performance, and ability to engage in daily life. They will work on body-brain connection, spatial awareness, overall motor skills, and fine motor skills. The occupational therapist will be able to define and adjust curative, palliative, and circumvention methods to determine a comprehensive management approach, and will ensure to adjust these methods over time according to the child’s development. The school intervention plan will be based on the occupational therapist’s recommendations. Here you will find an intervention and planning kit for the school intervention plan (in French):   https://blogues.csaffluents.qc.ca/trousseehdaa/plan-dintervention/plan-dintervention/

For children with a language delay, there will be an assessment and a referral for speech therapy.

It is important for a child diagnosed with dyspraxia/DCD to consult an optometrist specializing in visuospatial/constructional dyspraxia to assess and determine whether there is an eye and/or a movement disorder.

Verbal dyspraxia

DCD/dyspraxia is a motor gesture planning disorder that often affects language. In such cases, it is referred to as developmental verbal dyspraxia or orofacial/buccofacial apraxia. This disorder is part of the family of speech sound disorders (SSD).

It is a language expression disorder characterized by the inability to adequately plan and organize mouth movements to produce sounds, words, or certain actions such as blowing, drinking through a straw, sticking out the tongue, etc. The child has difficulty planning and organizing the movements needed to speak. This disorder significantly hinders the number of words produced as well as pronunciation, verbal fluidity, and consequently, speech intelligibility. However, comprehension is minimally affected. A child with verbal dyspraxia will therefore have difficulty being understood by those around them while understanding what is said to them, and will know exactly what they mean to say.

This language disorder should not be confused with developmental language disorder (dysphasia), where there is an impairment in both expressive and receptive language.

A referral for speech therapy will generally be recommended around age 3. Following diagnosis, the child will have to work on rehabilitation aiming to automate the movements needed to produce sounds. In most cases, the probability for successful rehabilitation is high.


Visuospatial dyspraxia is a disorder associated with the brain, motor skills, and eye muscles.

Visuospatial dyspraxia has a very serious impact on the child’s daily life as a result of inadequate visual scanning of their environment.

All information coming through their eyes will be compromised.

Additionally, everything they look at will be misunderstood and misinterpreted.

There are 6 external muscles that govern:

  • Visual fixation (ability to look at a static object);
  • Alternating fixation (ability to alternatively look between two objects);
  • Visual tracking (ability to follow a moving object);
  • Visual exploration (ability to perceive three-dimensional and two-dimensional space, e.g. writing on a sheet in two dimensions);
  • Visual convergence (ability to use both eyes together to allow for clear vision in space);
  • Visual saccades (ability to use micro-movements of the eyes to sweep information).


There is an internal muscle that governs:

  • Visual acuity (ensuring the image is well projected onto the retina through the work of the lens).


Here are the relevant questions to ask when making an appointment for an evaluation of visuospatial dyspraxia according to optometrist Jean-Pierre Lagacé:

Beyond the traditional visual examination (visual acuity test, assessment of eye health, hypermetropia, myopia, or astigmatism):

  • Do you perform eye alignment and focus tests, specifically for near vision?
  • Do you perform visuomotor tests (eye movements, reading speed tests, etc.)?
  • Do you perform visual perception tests (visual memory, hand-eye coordination, visualization, visual discrimination, etc.)?
  • Do you conduct spatial location/orientation tests?
  • Do you offer structured visual rehabilitation treatment for all of these issues (e.g. monthly visits for 6-12 months depending on the issues encountered) rather than just one or two activities with a follow-up visit after 6 months?



Association background

Created in 2004, the Association québécoise pour les enfants dyspraxiques (AQED) was originally established by a group of parents. In 2003, with the help of a community organizer from the CLSC in Sherbrooke, the AQED explored the possibility of merging with another community organization, including the Association québécoise pour les enfants dysphasiques (AQEA).

Quickly, the parent group discovered that the physical and functional disabilities caused by dyspraxia differed from those observed in children with dysphasia. It became clear that children with dyspraxia had specific needs for rehabilitation and support.

These differences led to founding an association whose services would be directed specifically to patients with dyspraxia while better responding to parents’ concerns.

In July 2004, the Association québécoise pour les enfants dyspraxiques was established and obtained its letters patent from the Registraire des entreprises.

Later, the association was recognized as a charitable organization by the Canada Revenue Agency. The AQED is recognized by the Agence de santé et des services sociaux de l’Estrie (ASSS) as a non-profit community organization.

In 2016, the association changed its name to TDC-Québec to reflect the change in the medical terminology in French for this disorder. This name change for the association provided an opportunity to include, congregate, and represent adults living with this problem.

Lastly, the association underwent another name change when a grant was offered by the CIUSSS de l’Estrie-CHUS through the Programme de soutien aux organismes communautaires (PSOC – community organization support program). We must therefore offer immediate and in-person services to the Estrie clientele. With the aim of adopting a meaningful and timeless name, Dagobert (known from a French children’s song as a king who put his underwear on backwards) was chosen. Dagobert and his supportive and helping company came out on top of the list, and thus Dagobert et Cie became our new name.

 


Our mission

PURPOSE

Providing support to people with developmental coordination disorder (DCD) and their caregivers.

 

OBJECTIVES

Facilitate the integration of people living with a DCD;

Educate stakeholders and partners on the needs of people with a DCD;

Raise the general public’s awareness about the realities of people with a DCD;

Inform about the importance of screening and referral to recognized services;       

Promote and facilitate social, sports, educational, and cultural activities adapted to people with a DCD;

Obtain, for the purposes mentioned above, funds or other property through public fundraising campaigns. 


Children and DCD/dyspraxia

The “how to” disorder

Dyspraxia is a disorder of planning the movement and coordination needed to achieve a new, oriented action for a specific purpose. This disorder creates varying degrees of difficulty in developing and automating voluntary gestures. Thus, the child appears unable to plan, organize, and coordinate their actions in the right sequence to produce a new action adapted to the environment in which they are acting. (Breton, S. and F. Léger, 2007)

Dyspraxia (DCD) is thus a “how to” disorder. Children with dyspraxia (DCD) learn to perform motor tasks through many repetitions, but this learning is not automatically applied in other situations. The person must therefore learn each variation of an activity as if it were completely new.

Dyspraxia (DCD) causes impairments that interfere with carrying out daily activities, school learning, and potentially with work.

Dyspraxia (DCD) is a developmental disorder that affects several brain functions: Integration of sensory information, visual perception, conceptualization, motor planning and execution, and anticipation of results. No cause has been definitively identified, but a difficult birth history has been observed in half of the cases. Dyspraxia affects 6% of children aged 5 to 12, and boys are two to four times more likely to be affected than girls. It should be noted that as of yet there are no statistics available in Quebec. 

School and daily life of children with DCD/dyspraxia

It is common for other disorders to be associated with dyspraxia.


Attentional difficulties

One of the most common disorders associated with dyspraxia (DCD) is attention deficit disorder (ADD), with or without hyperactivity (ADHD). Thus, children with dyspraxia (DCD) who also have ADD/ADHD characteristics could benefit from ADHD treatment; however, it must be stressed that medication only treats attention and concentration difficulties and does not treat dyspraxia.

There is also a need for a high degree of vigilance in any association with ADD/ADHD and DCD. Some characteristics, such as a lack of muscle tone caused by dyspraxia, may indicate that ADHD is associated since the child often changes position and cannot remain seated due to physical discomfort. Additionally, children with dyspraxia (DCD) may seem inattentive, but this is not truly the case, due to the inherent difficulties in dyspraxia (DCD) related to processing information, visual perception, and speed of execution. Therefore, caution is needed to prevent diagnosing ADHD too early, since children with dyspraxia (DCD) that do not actually have an attention deficit will not see their condition improve with medication.


Learning difficulties 

Many children with dyspraxia (DCD) experience learning difficulties at some point in their schooling. Difficulties can affect various subjects with varying severity depending on the child and their degree of education. 

In kindergarten, children with dyspraxia (DCD) are clumsy in colouring and cutting activities and have difficulty putting together pieces of construction games or puzzles. They tend to play the same games repeatedly and watch their friends rather than play with them.

In elementary school, learning how to write is particularly arduous; these children cannot hold pencils well, have great difficulty shaping letters, and are slower than their peers. As years pass, learning mathematics also becomes increasingly laborious, and subjects such as physical education, music, or the plastic arts, far from opportunities for recreation, are rather sources of failure and frustration that contribute to low self-esteem.

In high school, while academic difficulties experienced in elementary school tend to continue, new organizational requirements represent the greatest challenge for teenagers with dyspraxia (DCD). The transition to high school brings about a number of changes in autonomy, social development, and schooling. To make this transition successful, the teenager will need support and compensatory means to help them succeed.


How to help


At school:

Dyspraxia often leads to failure at school. It is recognized as a physical handicap requiring specific support measures.

Several support measures promote using a keyboard, and computer programs can be implemented to facilitate writing and spatial awareness.

An adapted schedule, time management methods, and facilitating space must be promoted.

In cases of dyscalculia, tools for learning mathematics must also be implemented.

Daily life:

Getting dressed, personal care, eating, tidying up, travel, and social interaction are all affected in varying degrees by DCD/dyspraxia.


At both school and home, three areas must be developed:

– Use of curative means (rehabilitation/reeducation)
– Use of circumvention means (avoidance)
– Use of palliative means (compensation through adaptation)


Balance and success lies in the perfect blend of these three areas. One must be able to determine when deviation from normalcy is too great and compensatory and circumvention methods should be preferred to rehabilitation.

Example: Deciding to stop practising handwriting when a minimum functional level is reached and switch to the computer for writing (compensation) and/or voice support (avoidance).





Teenagers and adults living with DCD/dyspraxia

DCD/dyspraxia is a lifelong condition, but with a strategic schedule and access to support, most teenagers and adults will be able to live an active life and undertake surprising challenges.

Some of the problems encountered in childhood may fade with learning, while others remain and can make their personal, social, and professional life more difficult. Dr. Michelle Mazeau, a specialist in dyspraxia, explains: “The prognosis of dyspraxia depends little on the severity of the dyspraxia. The child’s development toward adulthood depends on various criteria. Early diagnosis, the level of school delay at the time of diagnosis, the isolation or non-isolation of dyspraxia, and the quality of care are the main factors for favourable or non-favourable development.”

People with dyspraxia often neglect their physical appearance. They need support in developing adequate body hygiene and to be informed on the importance of a well-groomed physical appearance. Strategies must be established to manage contraception, excluding methods requiring manual dexterity and time measurement. In terms of clothing, the person with dyspraxia could be accompanied by a friend or family member to purchase clothes. Being different does not mean having to look different, unless it is by choice. Plan for easy, convenient financial management. Use a credit card to avoid handling money and use the Internet to access bank accounts and pay bills. People with dyspraxia are rather capable with these technologies.

Physical exercise and a healthy diet are not usually concerns for people with dyspraxia. They can join a gym by requesting an individualized and personalized program. In this way, they have short-term goals and are not in competition with others. Meditation and yoga are disciplines that can have a great beneficial effect on the anxiety experienced by people with dyspraxia. Developing suitable strategies for the kitchen is also required. Selecting certain utensils and making a list of favourite recipes can greatly facilitate implementation of a routine. Recipes can be adapted by dividing them into sections (preparation of materials and preparation of ingredients), and highlighting the steps for preparation can be useful. All this effort is intended to make it a fun time rather than a chore.

For socializing, it is more difficult to create a circle of friends, however, through meetings at school or work, there are great opportunities to do activities. Volunteering is a great way to feel useful, and the people receiving help are grateful and often develop good ties with the volunteer. People with dyspraxia will thus become caregivers rather than always being the ones in need of receiving help.

Career choice greatly depends on the level of dyspraxia and the presence of comorbidities (associated disorders). In the case of a person with dyspraxia and no comorbidities, employment that can provide a stable routine will be favoured. Additionally, jobs that can provide work free from pressure should be considered. People with dyspraxia experience constant fatigue, therefore adjusted work schedules are often needed for comfort and performance.


Videos

Better understanding DCD/dyspraxia

From diagnosis of DCD/dyspraxia to rehabilitation

The impact of DCD/dyspraxia

Tools

Please refer to our social media accounts for access to our posters. We are also happy to provide them to you in PDF format upon request.

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    Pediatric rehabilitation clinic

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    Association representing learning disorders

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